What starts as substance abuse can quickly proceed to addiction once a tolerance to the substance begins to form. From there, many people fall into the trenches of dependency where their entire lives start to revolve around substance abuse and subsequently fall apart due to it. When this occurs, a lot of people who abuse drugs and alcohol start abusing themselves too.

What Is Self-Harm?

Self-harm involves purposefully injuring oneself, typically externally. The goal is not to commit suicide or cause permanent injury, but to release emotional or mental tension and upset by way of physical acts. Some examples of self-harming behaviors include:

Cutting the surface of the skin

Biting oneself

Burning the skin’s surface

Pulling out hair

Picking at scars to reopen them

Hitting oneself

Signs of Substance Abuse and Self-Harm

There are various signs of substance abuse, some of them more obvious than others. People who abuse drugs or alcohol will sometimes smell like the substances of abuse, so pay attention to odors. Take note if the person is neglecting responsibilities, failing to care for children properly, or slacking at work. Legal ramifications, such as being arrested for possession of certain drugs or paraphernalia, or for driving under the influence, are also red flags. Risky behavior that is unusual for the individual and lashing out at loved ones are other signs that something may be off that could involve substance abuse.

Self-harm practices may be slightly more difficult to spot, because the signs of self-harm can be hidden beneath clothing, and they usually are. People who engage in these behaviors carry some sense of shame over the practices and know that it isn’t socially acceptable. As a result, they will go out of their way to hide the self-harm. Look for:

Burn marks or cuts that haven’t healed since the last time they were noticed

Bald spots on the head

Scars that are building upon other scars on the surface of the skin

Wearing long-sleeved shirts and pants in hot weather

Trouble with interpersonal relationships

Lacking self-worth or hope for the future

Root Causes of Substance Abuse

Addiction doesn’t appear out of nowhere. It stems from substance abuse, which is often a behavioral consequence of certain lifestyles. Many children grow up in homes where substance abuse is present. The Child Welfare Information Gateway notes around 12 percent of children in America are living with a parent that abuses drugs or alcohol. As a result, they are at an increased risk of developing substance abuse habits of their own. For example, the National Institute on Alcohol Abuse and Alcoholism reports a child whose parent abuses alcohol is roughly four times more likely to develop substance abuse problems as an adult than someone with sober parents.

In addition, various other factors contribute to the formation of substance abuse patterns. These can include peer groups that engage in substance abuse, genetic predisposition to addiction, and attempts to self-medicate depression or other mental health issues with substances.

Self-harming habits often develop as a haphazard side effect of mental illness. The coexistence of mental health disorders and substance abuse is not uncommon. About 29 percent of people who have a mental illness also engage in drug or alcohol abuse, Psych Central states. Anxiety and depression are two of the most common mental health disorders diagnosed today. They cultivate feelings of worthlessness, paranoia, and sadness that often leave the individual looking for an outlet to escape the emotional and mental pain that plagues them. Substance abuse and self-harm are both common outlets.

Individuals who suffer from mental health disorders and aren’t aware of it are at the greatest risk for substance abuse. Mental illness does not make someone crave drugs and alcohol. It’s not a symptom of mental discord. Rather, it’s the need to cope that sufferers reach for. Drugs and alcohol can numb physical pain, but they also numb emotions too. They make the stress of responsibilities and insecurities fade into the background.

For many people with mental health disorders, they’re living their lives completely unaware of their illness. They aren’t unaware of the symptoms though. People who don’t know they’re suffering from clinical depression still feel depressed. People who don’t know they have bipolar disorder still have mania and the insomnia that comes with it. Those who live with generalized anxiety disorder and don’t know it still know they can’t stop worrying. They might start to slowly realize the only time they feel better is when they take over-the-counter drugs to sleep or spend a few hours at the bar with friends. Slowly, they turn to those practices more and more in an attempt to feel better. That’s all they actually want: to feel better.

Self-harm works much the same way. It is a coping mechanism just the way that substance abuse is. Often, the negative feelings these individuals harbor almost seem like they’re stuck to them. They shake them off by self-harming. People who cut themselves feel a sense of emotional release through the pain and bleeding. Individuals who burn or hit themselves experience the same sensation. It sounds extreme to outsiders, but the practice itself actually has documented effects on the brain. In other words, it works.

Smithsonian Magazine notes that emotional and physical pain are actually perceived and processed by the same regions of the brain. Thus, medications – or actions like self-harm – that act upon those regions to relieve emotional pain for many people just as they do physical pain.

Going untreated is risky enough to begin with when substance abuse is occurring. Adding self-harm to the picture makes things even more dangerous. There is a serious risk of death even when the individual is not intending to commit suicide. The National Hospital Ambulatory Medical Care Survey reports 836,000 self-inflicted injuries were treated in American emergency rooms during 2011.

When substance use disorders are ignored, they tend to get worse. Addictions grow stronger and harder to recover from. Many people will also start out abusing one substance, but over time, they start abusing others. For example, people who abuse marijuana often end up abusing other substances in the future. A Columbia University study notes adults who abuse marijuana, tobacco, or alcohol are 323 times more likely to use cocaine than the general population. In 2012, 56 percent of people aged 12 and older who were admitted for treatment reported the abuse of more than one substance, SAMHSA reports.

Furthermore, when substance abuse and self-harm are accompanied by a mental health disorder, the absence of treatment means the mental illness is allowed to grow deeper roots. The longer mental illness goes undiagnosed and unmanaged, the more difficult it usually is to treat.

Get Help Today

Often, the person who needs help for substance abuse and self-harm is the last person to actually see that need. In some cases, they may be aware of their need for help, but they are reluctant to admit it and would rather continue ignoring the major issues at play. Confronting a loved one who is engaging in these behaviors is tricky. Generally, the outcome of such will always be more favorable if a professional interventionist is on board to help.

Both inpatient and outpatient treatment modules are quality options for rehab. That being said, they are geared to treat different clients with varying severities of addiction and other illnesses. In 2013, 17 percent of all admissions to treatment were for inpatient care, per SAMHSA. Most of the people who require this type of intensive care either have co-occurring mental health issues that make them a threat to themselves or others, or they have sought outpatient care in the past and relapsed.

In cases of self-harm, inpatient treatment is often necessary. Some clients will need the supervision that comes with this type of rehab setting in order to stop the behavior. If they cannot reign in control over the compulsion to cut or burn themselves, the supervision that inpatient treatment provides may be necessary.

Cognitive Behavioral Therapy and Dialectical Behavior Therapy are the primary treatment modules used to rehabilitate people with self-harming tendencies. These techniques teach clients how to approach triggers, such as emotional upset or intrusive thoughts, in a safe way and manage the way they feel without needing to release their feelings via self-harm. That being said, in most cases, self-harm is merely a symptom of a bigger issue like depression. Treating the depression will mitigate the symptoms.

It is always best to reach for the root cause when treating substance abuse and mental health disorders. Treating only symptoms will leave the individual exposed to a greater likelihood of relapse down the road.

When substance abuse must be treated in conjunction with self-harming behaviors, careful consideration must be given to how the individual will cope with the potential discomfort of withdrawal. Typical side effects, such as depression or pain in the joints, may lead someone who regularly self-harms to try to do so again. Spending time with peers in group therapy sessions and attending individual therapy on a regular basis can help these individuals to cope in healthier ways.